Category Archives: Interview

We are pleased to share with our readers yet another short but interesting interview conducted at the latest Global Forum with Dr. Cécile Wendling:

Please introduce yourself and tell us about your participation at Global Forum.

I’m the head of foresight at AXA and I’m also a researcher, an associate researcher at the center of sociology of organizations in Paris (Centre de sociologie des organisations (CNRS-SCIENCES PO PARIS) in sociology of risks and catastrophes). Today we are at the Global Forum and I will speak at the Digital Communities Session about the future of health, I will explain what are the new trends and I will talk about the health of tomorrow. For AXA it is very important to consider the role of Digital Communities. We think that there are a lot of people that are not covered by insurance today: most of the time they are too “rich” to have a public coverage and too “poor” to have a private coverage. But we think that these people could access insurance with digital tools.

How do you see the Health Sector develop in the next decades ?

The Health is going to be really revolutionized by Big Data first of all. There is a lot of Data Sets that we could not exploit before and that we will manage to use. This data is more and more “cross-sectorial”, so you can cross data of mobility with data of health etc.
Second, there will be new actors entering the game because there is a question of prevention and how well-being can enhance health. It is very important to know today which are the prevention tools that are working and those that are not working; one of the big issue is how do we measure the impact of prevention.
Third, the new tools can empower patients so that they can have more information about their disease and be a more active actor in their treatment . This is of course going to change the relationship between the patient and all the people around him.
Fourth, there will be a new way for people to share their problems and be insured globally. We see more and more start-ups who bring together people who share a disease but also share coverage. This is an ecosystem that is moving quite fast.

Could you please repeat the example of women selling mangoes that you gave us during the conference preparation meeting ?

Yes, it was about the fact that there are a lot of people that are not covered by the insurance. There is this example in Vietnam of women selling mangoes and water in front of bus stations and Bel – the group Bel – wanted them to sell their product La Vache qui rit® and the women refused at first. They were asked if there’s anything that’ll make them change their decision; the women set obtaining a coverage for accidents as a condition. Most of the time they arrive in the morning on a bicycle and if they have an accident it is the entire family who is at an income loss. Bel then promised to turn to an insurance company for a micro-insurance.

The example is very interesting because there is no contact between the insurance company and the women but it’s Bel who is embedding the insurance coverage into the program. This is also existing in Mexico with Oriflame. It is not only one story, there are many cases today. And we really think at AXA that this is the future of insurance, that we can embed the insurance for those people who have difficulty to access it.
Another example that I can give is parametric insurance in Africa that we are working on. It is very difficult to cover farmers of agriculturists if there is a drought for example and nobody insures them. There’s today satellite data that measures the level of humidity in the soil and as soon as the soil is under certain threshold of humidity an insurance system/ payment is triggered. Because of the satellite data and mobile payment we can reach people and afford to insure people we couldn’t before.

The future will certainly lie in the new tools for the better good of people.

GLOBAL FORUM 2016, organized by ITEMS, an international firm in Information & Communication Technologies strategies, just took place this past September. The WeObservatory is traditionally moderating the Digital Communities Session and we have had the chance to sit down and talk to some of the session’s speakers.

Here’s the interview with midwife, reasearcher and developer Franka Cadée on her project:

“My name is Franka Cadée, I am a Dutch midwife although not practicing any longer. I’m here at the Global Forum today to speak at the Digital Communities session about my twin2twin project.

I have developed a method where midwives can work together across cultures which is different from development aid. It’s a system whereby you learn from each other. I think we’ve learned through the ages that there are certain sides to development aid that simply do not work because it’s dominating from one culture to the other. So this is an answer to that.

What we are doing is working between midwives and at the beginning of the project try to see what the other culture has to offer: it’s like a barter system. We discuss with one another what we want from each other and then start a partnership. And the partnership isbased on reciprocity, which means that you give and you learn how to receive and you learn how to give back, it has to be an equal exchange. So it has lots of challenges, but through those challenges you find that midwives really get to know each other. I also believe that by giving you actually gain power, you don’t gain power by only receiving – what I think is often wrong with development aid.

We do find that it is especially the “giving” aspect of the project that really makes the midwives feel strong; and strong midwives means that they work well and they take care of strong women that give birth.

We’ve developed a whole method that takes 4 years (although you can adapt it) with a series of workshops, people with similar interests are twinned with each other. We match people slightly on age, but mainly on interest so we have teacher midwives with teacher midwives, students with students, researchers with researchers. They work with each other and develop a small project together. What we’ve been fighting hard is the communication: language-wise it’s hard, cross-cultures it’s hard, but also Skype often doesn’t work or phoning is expensive, we’ve been using WhatsApp a lot, but that is also hard sometimes.

Getting the methodology across, how we work and when we meet has been hard to figure out.

So having a Mobile App for this is really fantastic.

It really helps the twins to understand what is the project, what is it about, what and when they can expect and we are hoping that they’ll be able to communicate through the App at some point.

Fo how long was the App idea around ?

It’s been around for about a year and a half, before that we did a book – that is outdated by now since we re-developed the methods. And in the last few months with the help of the WeObservatory it’s come to life. And it’s really amazing to see and I do believe that in certain countries midwives that don’t have good Internet access all the time can download the App when they do have access and have it on their phone.

Somehow it’s really inspiring to see it this way, it’s quite different having it for yourself than just only hearing about the methodology. Anyone who wants to do a twinning project can basically download the method.

You mentioned you are doing a PhD. Can you please talk about the research you’ve been doing ?

I’ve been researching twinning in general (every single article on twinning is in the App). People have twinned for ages since the Second World War. But what you find in Healthcare is very unclear. People don’t know what it is and what it stands for. I’ve done a concept analysis of the word twinning and it’s about to be published in a Journal called Globalization and Health. Basically we’ve come up with a new definition of what twining in Healthcare is and what are the basic ingredients of twinning in Healthcare. I’m also doing a study with all midwives who’ve done twinning, it’s about 50 people. I’m asking them what are the critical success factors in twinning. And I’m doing some work on network analysis and results of their projects . I hope that in the future we’ll be able to really compare the projects by their outcomes.”

To continue the tradition of Medetel interviews, here’s a most interesting discussion that we had with the very experienced nurse Claudia C. Bartz:

“I’m Claudia Bartz, I live in Wisconsin, US. My lifetime as a nurse includes a career in the US Army, I retired in 1999 and then I spent about 5 years at the University of Wisconsin at the College of Nursing, teaching a few semesters and I was project director on 4 grants. Then I met the person at the University who was working for the International Council of Nurses and we decided, back in 2005, that I would work with her and since I spent 10 years with ICN. It is a really fantastic opportunity to see the international side of nursing ! Then in 2009 I started managing the new ICN Telenursing network.

About the same time the ISfTeH invited the ICN CEO to give a plenary speach here at Medetel and David was unable to come and I ended up doing it instead of him. So that was my first introduction to Medetel and it was really great and from the start I found it was an organization open to nursing, partially because Frank Lievens is soliciting nurses and other professionals in addition to physicians and I’ve been coming every year ever since and presenting at least one paper.

Several years ago we started organizing virtual nursing sessions too and also during the year we had several educational sessions using the animated platform from the ISfTeH. So, it’s been really great, I really find it a very welcoming organization, I like the smallness of it and multidisciplinary nature. My primary wish would be that more nurses could attend, unfortunately they don’t have the money for registration and traveling.

Then I retired from ICN and University in 2015 and now I’m self-directed. I’ll plan to stay as the chair of the Telenursing working group, make a contribution as much as I can.

Why an interest in Telenursing ?

A long time ago, when I was working as a clinical nurse I worked in critical care. So you are exposed to more machinery there than in any other kind of care delivery and I was never frightened, I guess, by new technology. And with the army I lived in Belgium and Germany, Ethiopia … around the world pretty much and I’ve seen a lot. And as distance education became more popular I could see that there was an application already in existence for healthcare and so many opportunities, I just joined the stream. It just makes so much sense to me. Now especially I live in a rural area and so much education needs to be done and so many opportunities exist for distance education.

Please explain what is Telenursing in practice.

It’s like asking what’s nursing, depends on who you ask. Telehealth nursing is nursing practice that deals with people with healthcare needs or people with educational needs (such as nurses or families) over distances and barriers. In a city area a barrier might be not being able to get to a healthcare facility. Or another example: a nurse from Nigeria came to Medetel a few years ago and explained how she worked with the nursing minimum data set (you collect the minimum data on every client and you have an idea of the culture of the clients; he vital signs, their location, complaints). I was here at Medetel , she was presenting her work and I was just so excited to see that the idea of the minimum data made it all the way to Nigeria. It was so exciting how she was helping all these women stay at home and not have to go the whole distance to the care facility to get the treatment that she could deliver at their homes. To me that was really a neat example.

Please give a short resumé of your presentation about Telehealth Education for Nurses.

What I’m trying to differentiate is normal education that we all need (all healthcare providers) versus Telehealth education and it goes back to the definition. Some of my nurse colleagues say “every nurse uses at least a telephone, so every nurse is a Telenurse”. But I don’t really agree with that. I think the Telehealth nurse has a greater commitment to not only using the available technology but to pushing further so that more and new kinds of technology.

Telehealth education is of course more about the ICTs and the new ways they can be used to advance the healthcare but also the issue of Data. Because you are obviously generating even more data than before. You acquire it, you store it, you use it … who’s data is it? All the questions around the ethics of data are a big issue for automated systems.

I pointed out that Telehealth care providers need to be motivated to learn about new things and not think “this is what I trained with, this is where I’m staying”. To my knowledge we don’t really have any Telehealth for Nurses master’s program, where as there are plenty of nursing informatics master’s programs. But that’s another specialty and Telehealth nursing gets buried under it”.

Next interview conducted at Medetel that we’d like to share with our readers is that of Dr. Pirkko Kouri, now vice-president of the International Society for Telemedicine and eHealth (ISfTeH) and an active member of it’s Working Group on Women. More biographical details to be found in the interview itself:

“I represent the Finnish society of Telemedicine and eHealth. My background is from nursing, I have done my PhD related to mother-child healthcare and use of ICTs. I’m working as a principal lecturer at the Savonia University of Applied Sciences, Finland. We educate nurses, midwives and other healthcare professionals as well. I’m mostly doing research and development work connected with the master level education, planning the generic models, etc.

This year I was elected vice-president of ISFTeH and i’m very happy to be the first woman to occupy this position.

Q: For you, what is the role of telemedicine ?

Telemedicine is a tool, a tool to combine different elements for people to be connected and exchange experiences around the world. Sharing information, getting information, be connected with patients and learn from each other.

Q: In your teaching curriculum, do you include materials on telemedicine?
Yes, for example I’m responsible for the Digital working environment, a web-base course. We have a team of three teachers : one from healthcare, one from engineering and one is from design and we plan the content together. Next year I’ll be the teacher in charge for the class Healthcare technology and it will be in English.

Q: How important do you think it is for healthcare professionals, nurses especially, to keep up with all the options the Digital offers in terms of healthcare ?

In Finland we have the Digital boom and digitalized healthcare, meaning that we have a nation-wide system and patients can join the system with their bank cards or any other identification and, of course, our nurses must know the benefits and what support we can offer. Face-to-face support and counseling, but also virtual, as it offers so many ways to share information and be in contact. Of course, it is a challenge to education as well: there’s a digital divide. Some people don’t have enough knowledge about ICTs and they need to have supplementary education or training at work, but it will gradually come.

The doctors are more specialized and deal with complex issues. So the guidance, mentoring and tutoring issues are more left to nurses. That is our challenge. Actually in Finland, we are tackling that: I was vice-chair of the group nominated by the Finnish Nurse Association and we launched in January the very first eHealth strategy for nurses and there are 6 different elements of this strategy that would be valid up until 2020. I think all the countries need to implement strategies that will allow eHealth to support the nursing practice; that nurses bring their expertise in the multidisciplinary development process and in collaboration with patients. Because patients themselves know quite a lot on how to use ICTs, especially young people.

The only thing to always keep in mind though is the ethical and privacy issues. Remember that Facebook is not the same as the Health Electronic Record. That is also a matter of education. Also, every time you send some kind of message in your own name there’s a kind of watch over you and you must remember all of the data collection and the traces you leave behind.

Q: You are also part of the Working group on Womena the ISFTeH. Which direction of work do you see this group take ?

Most importantly we should keep the neutrality in our work when addressing the gender issue. We should bring in facts and rely on facts and underline the positive elements of our work. We must be intelligent about which the direction we take.Healthcare and eHealth is definitely an area that we should proceed in. Women are very present, I’m thinking mostly of nurses now, and most of them are women if we consider the global situation.Digitalization is a new thing to consider and many things are to be learned, but many nurses, especially the older ones are hesitant in accepting changes brought by digitalization and it is something we need to work on.

Overall, speaking of the Working group on Women, we should push the opportunities for equality but in a politically neutral way.”

The last Medetel event – organized every year by the International Society for Telemedicine & eHealth (ISfTeH) – gave us an opportunity to chat with various professionals that work in Healthcare. This week we’ll be publishing the most interesting parts and highlights of the interviews, starting today with Elinaz Mahdavy’s (of Orange Healthcare) interview about eHealth strategies and our own WeObservatory projects.

“What I would like to see happening is that eHealth becomes a harmonized process, I mean in Europe , that all the countries have the same strategy on eHealth and mHealth. As you know Europe is very fragmented , so we still have a long way to go. But the EU policy makers are doing all they can for some years now and recently it is becoming more and more important to have a harmonized healthcare system in general and eHealth strategies in particular. That’s where I would like to see Europe being unified go in terms of eHealth,” says Elinaz Mahdavy.

When asked about the importance of community and gender targeted projects , like those that we support here at the WeObservatory, she added , “Project like these definitely have a place to be. As a woman I think we are important drivers. Moreover, a digital society can only be a benefit for many of those who – depending on the country they are in – are pregnant and/or are bringing up their kids on their own.”

“I’m Rob Fraser, registered nurse in Canada, I work in Toronto and I have multiple roles in things that I’m involved with. Right now I full time work in research and development translating clinical research guidelines into written documents that help nurses and physicians carry out best practice. I also work clinically at a hospital. The third thing I do on the side is consulting work and supporting healthcare organizations around online engagement of care providers and patients.

What kind of organizations do you work with?

Canadian nursing association, the Nurses Association of Ontario, a number of hospitals and Sanofi Pharma Company. During my undergraduate studies I’ve become aware of the lack of use of technology within healthcare. My role is to work with those more experienced clinically and teach them to use the new tools that become cheaper to share content and advance healthcare. I’ve been working for 6 years like that. There is a lot of interest from researches who are very focused on what they are doing and are not always aware of the changes going on “outside”.

Please tell us a little about your education.

I did my undergraduate at Ryerson University and then my masters of nursing at the University of Toronto. I was fortunate to be pushed towards the profession by one of my best friends – my mother – after I traveled to India and Trinidad to do volunteer work around care and community development she suggested that I consider the profession.

When I looked into it, it turned out to be a university degree and it was becoming more advanced and specialized in research. It also had a very close relationship with patients.

Plus, as an undergraduate I could already start working and go back internationally and bring a skill set and knowledge and expertise rather than just help clean and do basic kind of things which don’t always have a long term impact.

I graduated in 2009 and because of a motorcycle accident I delayed working clinically until 2011. I was taking time to recover and do the masters. And that’s also when I wrote a book on how nurses can use social media. Which was published by an honors society.

Did you feel any major changes or shifts within the profession from when you started ?

That’s one of the interesting parts: I don’t think I noticed a huge shift from when I started (counting my first clinical practice as an undergraduate). The pace of change in healthcare is much more slow and deliberate versus the changes that we see in technology and business. And I think these changes start to have an effect that is starting to accelerate the pace of change in healthcare.

Things available online are still not nearly caught up with some industries, but it slowly starting to pick up the pace.

What is the future of nursing in your opinion?

Interesting question. There always discussions around scopes of practice within the medical profession, everyone is sort of fighting for the old “access to power” in medicine.

For me the real value is the proximity and trust the nurses have with patients. The more we focus on enhancing that, the more we help guide patients through healthcare, monitor them in their home and community, work in health promotion and prevention, the more we’ll have and expanding role. For me it’s really important that we focus on staying close to the patient and not dividing “pieces of care”. It is indeed a specialty of the non-specialist, but the diverse skills that we have to incorporate in our practice makes the profession very interesting to me.

Speaking of social media, what is missing for nurses?

The comfort level of trying out new things and applying them is missing. Nurses are still waiting to be shown the best solutions versus picking up different avenues and trying to use online resources for patient education. Of course, it’s a big challenge in terms of time, especially for average registered nurses. But in hospitals there are nursing educators, administrators and professors who should explore these opportunities.

Plus, we have been used to doing things behind closed doors and in protection, so there are a number of trials done in closed communities and hospitals, which benefit a limited number of healthcare professionals. We fail to mirror the methodology that, for example, someone working on IT solutions are using: they develop a peace of code and then share it for others to expand on that work.

What value do you see in online projects and initiatives for nurses?

What is really important is the offline/online “space”. The majority of people connected on social media have an offline relationship to start with. There are very few communities that formed online only. I’d want to see works and initiatives that are blending and expanding relationships that exist offline and help people find other individuals that work on similar healthcare topics to collaborate immediately. And not wait for that once-a-year conference to start working together.

It has been interesting to keep an eye on Connecting Nurses, for example. The authenticity of the stories and videos has had a strong effect: especially seeing some of the local settings of where the innovations are taking place. There is a level of trust that is being established when people can listen to individual stories first hand.

It’s also interesting the way that this content gets received by nursing professors, leaders and teachers that are looking for information to demonstrate initiatives. The Connecting Nurses videos are well produced and are pushing an innovation agenda. I like the idea of working interstitially to connect different things that are happening and not necessarily to generate unique kind of expertise, as Connecting Nurses does.

What are the online resources you yourself use the most?

Probably podcasts. What got me interested in technology was being able to learn when I did other things. It started when I was having a job driving 8 hours per day to pick up golf balls… so I was listening to lectures.

And when I’m asked to talk to nurses about online resources I try to talk about digital tools in general and not social media only. Getting a Facebook or Twitter is not necessarily going to be of any use. It’s about accelerating the work that you are doing and not about having another account.

I really encourage nurses to use digital tools because if we are accelerating the work we care about, there is always going to be an interest and a value in that.

What we really see in the adoption of social media and youtube type of platforms is the interest. People keep going there because they are able to connect with others both offline and online and get to the purposes that interest us and are practical.

Of course, “digital” doesn’t always mean “better”, sometimes the “offline” is more beneficial. I’m very much about balancing the two”.

“This brings us to the one of the biggest challenges in mobile Health : itsability to scale up. There is tremendous amounts of small projects and pilots that are showing great evidence, but everyone needs to move to the next stage”

“Are we all connected ?” , a presentation made by Florence Gaudry-Prekins will give you a good idea on where we stand in terms of mobile connectivity in general and its role in advacing healthcare worldwide. A particular focus is made on Diabetes and mHealth as the presentation was made during the 2014 Diabetes Education Study Group Annual Symposium. And an important further reading suggestion is brought up: The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care by Eric Topol.

Florence Gaudry-Perkins is currently International Director for Global Sector at the headquarters of Alcatel-Lucent. Her current position entails relations with governments, multilateral and bilateral funds, as well as international organizations, an ideal platform to address the economic and social enabling effects of mobile technology and broadband in the developing world.

Her past work in higher education and familiarity with global health has influenced her in being a strong advocate of mHealth and mLearning for health in particular. She believes that global corporations now hold a responsibility in bringing their core technologies, products, services and competencies to form alliances with NGOs, Social Entrepreneurs, Foundations, Governments and international organizations to help develop sustainable business models which can then be easier to scale and replicate across regions and markets.

The video provided further down contains the entire presentation. However, here are some important citations :

“Mobile -cellular penetration rates are 128% in the developed world and 89% in the developing countries. Its quite astounding, we’ve never in the history of mankind have had a communication technology as pervasive and ubiquitous as this one. It opens up immense possibilities in terms of reaching out and it has great significance in the field of health and education.

More and more people are connecting via mobile phones as opposed to computers. The idea of having an intelligent computer in your pocket is no longer a futuristic vision and we need to get ready for that. It is taking the health world longer to realize this is happening and I think we need to accelerate the movement because this cannot happen without the health world coming on board and seeing the opportunities.

The following important aspects were brought up:

– Smartphones usage is growing worldwide, even in developing countries.

– mHealth projects are conducted worldwide. Some data from the 2013 survey done by GSMA, the association of mobile opereators based in the UK : in Europe about 117 , in Africa 363 projects. We see tremendous innovation coming out of developping countries and it is something to keep in mind.

– The scene on mobile applications is different. As you can see : 3000 to 4000 applications coming of North America, in Europe a little bit less and in Africa only 21. The question is , are they reaching people ? Only the top 5% of the Apps have reached more than 500 000 persons. ”

Upcoming Events

Barcelona’s Helthio is an event that brings together more than 10,000 citizens and healthcare system users, with more than 5,000 healthcare professionals and about 1,000 companies from diverse backgrounds. Here’s a throwback to our own and ZMD experience at Helthio 2017 :